Heart failure in Finland: clinical characteristics, mortality, and healthcare resource use

The high mortality rate of heart failure (HF) patients compared to age-matched controls highlights the severity of the disease and the need for new, improved treatment options, as shown by a new real-world evidence study conducted by Medaffcon.

Heart failure (HF) is a complex syndrome caused by abnormalities in cardiac structure or function. The worldwide disease prevalence is rapidly escalating and is estimated to be between 1-12 % in Europe and the US, increasing with age. The ejection fraction (EF) of the heart is used to classify HF to two groups of approximately equal size: those with preserved and reduced EF. Preserved EF is more common with women, elderly patients, and patients with persistent hypertension, but the distribution of the Finnish HF patients between these two groups has not been studied before. In our new retrospective, registry-based study, the aim was to describe the characteristics of the HF population in Finland, and to estimate the disease incidence, prevalence, mortality, and survival, as well as health care resource utilization.

The study was conducted using the electronic health records of adult patients diagnosed with HF in the hospital district of Southwest Finland between 2004 and 2013. The study included two patient cohorts; the first cohort of 15 594 patients included all patients with the diagnosis and was used to estimate disease incidence and prevalence, while the second cohort of 8 833 patients included patients who had given consent for a more detailed analysis at the patient level. An age- and gender-matched control cohort was established for the second HF cohort, to enable comparisons between health care resource utilization, comorbidities and mortality between HF patients and controls.

The incidence of HF was 3.2/1000 persons and the prevalence was 13.9/1000 persons in 2013. Both the incidence and prevalence increased rapidly with age and were relatively stable during the study period. Of the 8833 patients in the second cohort, 71 % did not fulfil the criteria for preserved or reduced EF due to missing data, which could indicate that no echocardiogram was performed, or there was no record of it in the health records. The most common comorbidities in the HF patient population were renal failure, essential hypertension, chronic ischemic heart disease, pneumonia, type 2 diabetes, atrial fibrillation, myocardial infarction and age-related cataract. All except for age-related cataract were more common in HF patients compared to controls. The mortality of HF patients was high compared to the controls, with a five-year all-cause mortality of 62.6 % compared to 28.3 %. Not surprisingly, age was the strongest predictor for increased mortality. HF patients also had more hospital visits (including outpatient clinic and emergency room) and more frequent hospital admissions compared to the control cohort, indicating a higher rate of health care resource utilization.

This is the first study examining the proportion of patients with preserved and reduced EF in Finland. Surprisingly, EF data was only available for 29 % of the patients, even though an echocardiogram is one of the cornerstones for HF diagnosis in the national guidelines. The HF patients with unknown EF were on average nine years older than HF patients in general, suggesting that an echocardiogram might not have been performed due to their higher age. This study also showed that despite receiving optimized care, HF patients continue to have a poor prognosis and high mortality rates, highlighting the severity of the disease and calling for further actions in the improvement of HF care.

Reference:

Huusko J, Kurki S, Toppila I, Purmonen T, Lassenius M, Gullberg E, Bruce Wirta S, Ukkonen H. Heart Failure in Finland – clinical characteristics, mortality and health care resource use among chronic heart failure patients. ESC Heart Failure (2019). DOI: 10.1002/ehf2.12443.